OBJECTIVES: The robot-assisted surgery system, or da Vinci system (dV), got reimbursed for the lobectomy for lung cancer in Japan in Apr. 2018, without any premiums. Additional evidence of relative benefits for patient was needed for getting premiums. Our objective is to assess the healthcare resource use of the dV against open and Video-Assisted Thoracoscopic surgery (VATS) for lung cancer patients in Japan.

METHODS: The claims data for hospitals with DPC (DRG-like flat payment system), obtained from Medical Data Vision Co., Ltd. were used for the analysis. Patient with the lung cancer and received either open surgery, VATS or dV were included for the analysis. The following components of healthcare resource use were measured; the length of hospitalization (entire length and after surgery), medical costs (hospitalization and whole one). Data were compared using the propensity score matching (PSM), incorporating six factors (age, gender, BMI, smoking history, stage of disease and the Charlson Comorbidity Index (CCI)).

RESULTS: A total of 15,870 patients were incorporated to the analysis. Using the PSM, 280 and 291 pairs of patients were matched for comparison against open and VATS, respectively. The length of hospitalization in dV arm was shorter than open surgery (13.4 days vs 8.6 days, p<0.01) and VATS (8.6 days vs 6.8 days, p<0.01). The dV arm was less costly for overall costs (1year after surgery) against open surgery (JPY 2.63 million vs JPY 2.27 million) and VATS (JPY2.46 million vs JPY 2.25 million).

CONCLUSIONS: Introduction of robotic surgery system may reduce overall healthcare costs in lung cancer area.